Informed consent dilemma: Jehovah witness and child die

The deaths in Australia of an unborn child and its mother who refused a blood transfusion because she was a Jehovah’s Witness have highlighted the risks of patient autonomy.

In a case in the Internal Medicine Journal, doctors at Prince of Wales Hospital in Sydney report that a 28-year-old woman with acute promyelocytic leukaemia refused all blood products even though she knew that her decision might lead to her death. Her foetus died in utero and she died several days later.

What were the responsibilities of the doctors treating the woman? The staff were distressed because they believed that both deaths were easily avoidable. However, the doctors note that: “

“maternal autonomy was respected – which reflects broad legal and ethical consensus that competent adults may refuse any form of medical intervention – even where that intervention is lifesaving… Circumstances where foetal and maternal autonomy conflict, or where foetal beneficence conflicts with maternal autonomy, create challenges… as more foetal-specific treatments become available, conflict between the best interests of mother and foetus will increase.”

Underlying the dilemma is the realization that if the woman had asked doctors to terminate the life of her child, they would almost certainly have complied – also out of respect for her autonomy. Sometimes informed consent leads to agonizing dilemmas.

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